Healthcare Provider Details

I. General information

NPI: 1275030793
Provider Name (Legal Business Name): PWT NURSE CONSULTANTS & HOME SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7034 MINIPPI DR
ORLANDO FL
32818-3345
US

IV. Provider business mailing address

1746 E SILVER STAR RD STE 107
OCOEE FL
34761-7014
US

V. Phone/Fax

Practice location:
  • Phone: 407-925-7237
  • Fax: 407-925-7237
Mailing address:
  • Phone: 407-925-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PHYLLIS WRIGHT TYSON
Title or Position: ADMINISISTRATOR
Credential:
Phone: 407-925-7237